Healthcare Provider Details

I. General information

NPI: 1720927080
Provider Name (Legal Business Name): FOUNDRA PRIME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 N WALDOCH DR
APPLETON WI
54913-8090
US

IV. Provider business mailing address

717 N WALDOCH DR
APPLETON WI
54913-8090
US

V. Phone/Fax

Practice location:
  • Phone: 612-442-2131
  • Fax:
Mailing address:
  • Phone: 612-442-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ABDINASIR GEDI
Title or Position: MANAGER
Credential:
Phone: 612-442-2131